Improving Care for LGBTQ Community

June 11, 2018 12:16 pm David Mitchell

Kevin Wang, M.D., remembers sitting in his family doctor's office as an adolescent and being asked questions about whether he had a girlfriend.

[headshot of Kevin Wang, M.D.]

"My doctor automatically assumed I was heterosexual and asked if I was dating any girls," Wang said. "I felt uncomfortable coming out to him, especially since he took care of our family. He's a phenomenal family doctor and one of my inspirations for choosing family medicine, but when I look back, it's something I know we can do better."

Lesbian, gay, bisexual, transgender and queer (LGBTQ) patients often face barriers to care, in part, because physicians aren't adequately trained to address their unique needs. A 2011 survey of U.S. and Canadian medical schools(jamanetwork.com) showed that more than 75 percent would rate their training related to LGBTQ care as fair or poor. Wang said LGBTQ training in medical schools and residency programs often has a narrow focus on issues related to drugs, STDs and HIV.

"Health care professionals sometimes forget we are a whole person, too," said Wang, who is a board member of both Seattle Pride and Planned Parenthood of the Great Northwest and the Hawaiian Islands. "It inspired me to do something about it in our residency and my community."

A few years ago, Wang started giving occasional lectures on LGBTQ care at the Swedish Family Medicine -- First Hill Residency Program in Seattle where he works. Those efforts evolved into a longitudinal curriculum that repeats every 18 months, ensuring that all residents have two chances to attend each lecture during their three-year training. He created an elective rotation that gives interested residents time to work with local experts in caring for the LGBTQ population. He also created an LGBTQ area of concentration where residents work with the community through volunteering and advocacy.

"The goal is for every resident to leave here feeling comfortable with caring for and working with the LGBTQ community," he said.

Wang is tracking progress on that goal by surveying residents on their comfort level caring for LGBTQ patients throughout their training. He's also working with other residency programs, making his lectures, handouts and surveys available to determine whether Swedish's results are replicable.

The residency program is also working to educate physicians who already have completed their training. In 2017, Wang launched an LGBTQ CME conference at Swedish Medical Center. The initial event highlighted the basics of LGBTQ care. This year's meeting focused primarily on transgender health and what providers need to know about gender-affirming procedures. Both events sold out. The 2019 event will focus on health disparities LGBTQ patients face.

Wang also teaches an LGBTQ Health Disparities Course at the University of Washington and is an adviser with the school's new LGBTQ Health Pathway. The pathway is an area of concentration medical students apply for to focus part of their training on caring for the LGBTQ community.

"I want the LGBTQ community to experience the kind of patient-centered and high-quality care they're looking for whether they see a family physician or other primary care provider," said Wang, who is also active in the AAFP's National Conference of Constituency Leaders and a member of the Academy's Commission on Membership and Member Services. "If I can make one more LGBTQ person's experience with a provider a positive one, then all of the work we've put into educating providers is worth it."